What Is Achilles Tendonitis?
The Achilles tendon connects the calf muscles to the heel bone and plays an important role when walking, running, climbing stairs, jumping and rising onto the toes.
The term Achilles tendonitis is widely used, although healthcare professionals often describe persistent symptoms as Achilles tendinopathy. This reflects the fact that longer-term tendon pain involves changes in tendon structure and load tolerance rather than inflammation alone.
Common symptoms may include:
- Pain or tenderness at the back of the heel or ankle
- Stiffness during the first steps in the morning
- Pain after sitting or resting
- Discomfort during or after exercise
- Thickening or swelling around the tendon
- Reduced strength when pushing off through the foot
Achilles tendinopathy normally develops gradually and may take several months to improve.
How May A Heel Lift Help The Achilles Tendon?
A heel lift raises the rear of the foot inside the shoe.
This reduces the amount of ankle dorsiflexion required during standing and walking. Dorsiflexion is the upward movement of the foot towards the shin.
By slightly elevating the heel, a lift may:
- Reduce stretch through the calf–Achilles complex
- Reduce ankle dorsiflexion during walking
- Make flat footwear more comfortable
- Temporarily reduce stress through the tendon
- Reduce compression at the back of the heel in some presentations
- Improve tolerance for everyday activity during a painful flare-up
The 2024 clinical practice guideline states that clinicians may use heel lifts temporarily to reduce ankle dorsiflexion during activity for people with midportion Achilles tendinopathy.
What Does The Latest Research Say?
Research into heel lifts for Achilles tendinopathy has produced mixed results.
A previous trial found heel lifts produced similar or slightly better improvements than an eccentric calf-exercise programme after 12 weeks. However, the difference only approached the threshold considered clinically important, so the authors advised caution when interpreting the result.
A newer 2025 trial compared genuine heel lifts with sham lifts in people with midportion Achilles tendinopathy. The heel-lift group experienced a slightly greater reduction in pain after 12 weeks, but the benefit was small, may not have been clinically meaningful and was not robust after accounting for participants’ treatment expectations. The researchers concluded that the findings did not support heel lifts as the primary treatment for Achilles tendinopathy.
This means heel lifts may still have a role as a temporary supportive measure, but they should not replace progressive rehabilitation.
Midportion vs Insertional Achilles Tendinopathy
The location of the pain matters when deciding whether heel elevation may help.
Midportion Achilles Tendinopathy
Midportion symptoms are normally felt around two to six centimetres above the heel bone.
A heel lift may temporarily reduce ankle movement and tendon loading during walking. Current guidance permits their use as a supportive tool, although progressive tendon-loading exercise remains the main treatment.
Insertional Achilles Tendinopathy
Insertional symptoms occur where the Achilles tendon attaches to the back of the heel bone.
Greater ankle dorsiflexion can compress this part of the tendon against the heel. A heel lift may reduce the amount of compression by preventing the heel from dropping as far inside the shoe.
Recent research found that a rehabilitation programme designed to reduce tendon compression—including heel lifts and limiting deep ankle dorsiflexion during exercises—improved pain and function more than a higher-compression programme in sport-active people with insertional Achilles tendinopathy. However, the trial assessed a complete rehabilitation strategy rather than heel lifts alone.
Are Heel Lifts A Cure?
No. Heel lifts should not be described as a cure for Achilles tendinopathy.
They change the ankle position while being worn but do not independently rebuild tendon strength or long-term load tolerance.
A heel lift may make activity more comfortable while rehabilitation takes place, but lasting improvement generally requires attention to:
- Calf and tendon strength
- Gradual load progression
- Sporting or occupational activity levels
- Footwear
- Recovery between demanding activities
- Sudden changes in walking or running volume
- The location and severity of the tendon problem
Current guidance recommends tendon-loading exercise as first-line treatment and advises that complete rest is usually unnecessary. Activity should instead be continued or modified within an acceptable level of symptoms.
Who May Benefit From A Heel Lift?
A heel lift may be worth considering if you:
- Find very flat footwear aggravates your symptoms
- Experience pain during ordinary walking
- Need temporary symptom relief during a flare-up
- Have insertional pain affected by deep ankle dorsiflexion
- Need help tolerating the early stages of rehabilitation
- Have been advised to use one by a clinician
- Want an adjustable method of trialling heel elevation
- Experience symptoms alongside calf tightness
The response varies between individuals. A lift that feels helpful for one person may make another feel unstable or transfer pressure elsewhere.
Should Heel Lifts Be Worn In Both Shoes?
For Achilles discomfort, heel lifts are commonly worn at the same height in both shoes—even where only one tendon is painful.
Using equal lifts avoids unintentionally creating a difference in leg height and may make walking feel more balanced. NHS Achilles guidance specifically advises placing a heel lift in both shoes for tendon symptoms.
Single-sided use may be appropriate where a clinician is managing a genuine leg-length discrepancy, but this is a different purpose.
Dedicated guide:
Should You Wear Heel Lifts In Both Shoes?
How Much Heel Lift Should You Use?
More height is not automatically better.
The 2024 guideline discusses firm heel lifts around 12 mm in previous research, while also recognising that there is limited evidence identifying the ideal height, progression or duration of use.
The appropriate height can depend on:
- The location of the tendon pain
- The person’s ankle movement
- Footwear depth
- Calf flexibility
- Stability
- Body weight
- Activity demands
- Whether the lift is being worn temporarily or prescribed for another reason
Beginning with a modest height may allow you to assess comfort without creating an unnecessarily large change.
Dedicated guide:
How Much Heel Lift Should You Use?
Should You Start At The Maximum Height?
Not normally, unless a clinician has recommended it.
A high lift may:
- Push the heel towards the top of the shoe
- Cause rubbing
- Make the footwear feel less secure
- Increase pressure beneath the forefoot
- Alter walking more than necessary
- Create discomfort elsewhere in the lower limb
An adjustable heel lift allows layers to be removed until the lowest comfortable and effective height is found.
How Long Should You Wear Heel Lifts?
Heel lifts are generally best considered a temporary tool during a painful stage rather than something that must automatically be worn forever.
They may be used:
- During ordinary daily walking
- At work
- During the early stages of rehabilitation
- Inside footwear that would otherwise feel too flat
- During selected activities that aggravate symptoms
As tendon capacity improves, the lift may sometimes be reduced gradually by removing layers. There is currently limited high-quality evidence establishing one ideal wearing period or tapering schedule.
A clinician can help decide when and how to reduce the height where symptoms are complex or longstanding.
What Footwear Works Best?
A heel lift needs sufficient room inside the shoe.
Suitable footwear should ideally provide:
- Adequate heel depth
- A secure lace, strap or fastening
- A firm heel counter
- Enough toe room
- A stable sole
- Sufficient width
- A removable liner where additional space is required
Very flat, flexible or unsupportive footwear may aggravate Achilles symptoms. NHS guidance advises supportive footwear and notes that shoes with some heel gradient or an appropriately fitted heel lift may reduce stress through the tendon.
Because the lift raises the foot inside the shoe, check that the heel does not begin slipping or rubbing against the upper edge.
Can Heel Lifts Be Used During Exercise?
Potentially, provided the footwear remains secure and the activity is appropriate for the current stage of rehabilitation.
Avoid first trying a new lift during:
- A long run
- A competitive event
- A demanding hike
- A full work shift
- An intense gym session
First assess it during ordinary walking. Increase activity gradually while monitoring symptoms during the session and over the following day or two.
Heel lifts should not be used to mask worsening pain while continuing an activity the tendon cannot currently tolerate.
Can Heel Lifts Make Achilles Pain Worse?
Yes, if the height, fit or product is unsuitable.
Possible problems include:
- Heel slippage
- Rubbing against the shoe
- Forefoot pressure
- Instability
- Calf discomfort
- New knee, hip or back pain
- Symptoms worsening after activity
- An uneven walking pattern
Stop using the lift and reassess it if symptoms become progressively worse or a new area of pain develops.
A temporary change in sensation may occur initially, but sharp pain, numbness or persistent discomfort should not be ignored.
Why Is Rehabilitation Still Important?
The Achilles tendon needs to regain the capacity to tolerate the demands placed upon it.
Progressive loading may involve:
- Isometric calf holds
- Double-leg heel raises
- Single-leg heel raises
- Seated calf strengthening
- Gradual resistance increases
- Progression into faster or more demanding activity
- Sport-specific exercises where relevant
The precise programme depends on whether the symptoms are midportion or insertional, the person’s current strength and the activities they need to return to.
The 2024 guideline strongly recommends tendon-loading exercise as first-line treatment, generally completed at least three times per week at the highest tolerable load.
Why Choose The 5 Layer Heel Elevator?
The 5 Layer Heel Elevator (Mid Density) provides adjustable heel elevation through removable EVA layers.
Key features include:
- Five adjustable layers
- Heights from approximately 15 mm down to 3 mm
- Firm-density EVA construction
- Adhesive layers for stability
- Non-slip top cover
- Compact shape for most everyday footwear
- Supplied as a pair
Its adjustable construction allows the user to begin with a selected height and reduce the elevation progressively where appropriate.
The Key Takeaway
Heel lifts can be a useful temporary support for some people with Achilles tendonitis or tendinopathy.
They may reduce ankle dorsiflexion and make walking more comfortable, particularly when flat footwear or compression at the back of the heel aggravates symptoms. However, recent evidence suggests their effect may be modest, and they should not replace progressive strengthening and load management.
Use the lowest comfortable height that achieves the intended purpose, normally wear equal lifts in both shoes for Achilles symptoms, and reassess the device if it causes instability or new pain.
